IMPROVING OUTCOMES FOR RESIDENTS AFFECTED BY DRUG AND ALCOHOL MISUSE Emma Stubbs Senior Commissioning Manager November 2019
Key areas § Background information: – Prevalence of alcohol and drug misuse in Islington – Impacts of substance misuse in Islington § Client feedback § Better Lives update and progress to date from a commissioner and a provider perspective § Themed feedback – Family Service § Performance: – Drug and alcohol treatment outcomes
Prevalence info § New estimates of the number of crack and/or opiate users (OCUs) and dependent alcohol users in Local Authorities were published in 2018. § These prevalence estimates give an indication of the number of people in a local authority area who are in need of specialist treatment, as well as a measure of unmet need, based on the proportion of those estimated to be in need who are not currently in treatment (June 2018) Data Source NDTMS Cohort and estimated number Islington unmet need National unmet need OCUs – 2168 60.7% 54.0% Opiate – 1749 54.4% 47.2% Crack – 1642 58.3% 59.8% Alcohol - 3704 81.7% 82.4%
Impacts of substance misuse
Impacts of substance misuse
Impacts of substance misuse
Feedback from service users Service User Involvement plays an integral role in the development and delivery of the integrated drug & alcohol service. In order to support this, Better Lives and the LBI Commissioning Team have developed clear plans and an approach that means participation, shared decision making and collaboration are the norm. A good example of stakeholders working together in this way is the development of ‘Mystery Shopping’ which has provided commissioners with greater insight into how clients are received when they arrive at services. Overall, the exercise found that all services were very helpful and answered awkward questions. Services were assessed by a secret shopper seeking help from services, and this “secret shopper” was also supported by a commissioner who visited the service shortly afterwards, to speak with staff and other clients to get their opinions. Areas of weakness were pointed out and acted upon, these included long wait times in reception, incorrect or outdated posters and promotional material, and unwelcoming reception staff/area. The Better Lives service has fed this feedback and insight back to all service staff, and changes have now been implemented as a result. Secret Shopper/Service user quote : “Helpful, Empowering and Inspiring to me”
Feedback from service users (cont.) Established users are generally satisfied with the new Better Lives service, although some new clients have reported some problems. The Service User forums have developed some positive initiatives but there has been with mixed engagement across the three main service sites: Grays Inn Road operating well Seven Sisters Road improving Mystery shop improved procedures Breakfast Club well attended King Henry’s Walk still to reach its potential Peer Mentoring programme has been a great success
Better Lives update (commissioner perspective) § Better Lives, the new adult Islington drug and alcohol service started on the 1 st April 2018. § Camden and Islington NHS Foundation Trust (C&I) are the lead provider working in partnership with WDP and Blenheim. § Significant logistical challenges in the first 6 months of operation: – C&I have invested significant amounts of money into refurbishing buildings in order to give service users, their families and staff comfortable and welcoming environments in which to transform their lives. – As buildings have been refurbished, the services usually provided from these sites have had to be relocated elsewhere. This has caused some anxiety to service users but through regular meetings and by involving service users in planning, service users are now more aware of the reasons for the changes and are more comfortable with the plans. – All eligible staff from previous providers have been transferred over to the new providers and the remaining key vacant posts, such as Borough Service Manager, have been successfully appointed to. Better Lives held a successful team building day to welcome all staff to the new service and to clearly set out the vision for the new service.
Better Lives update cont’d Positive feedback from partners about the proactive and flexible engagement of staff from Better Lives includes: • working alongside community safety colleagues in the Stroud Green Road area • attendance at a range of community events over the summer, including most recently StreetsFest in Finsbury Park. • the provision of services at the Floating Hub as part of the GLA funded No Second Night Out pilot • working with children’s services around the Keel Project (supporting families affected by DVA, mental health and substance misuse). New areas of work: • Better Lives launched a pilot project based in GP practices to work with people who are being prescribed benzodiazepines and opioids and who may be showing signs of dependence. The project will support people with a medication review and work with those who would like to reduce their reliance on medication.
Better Lives update (provider perspective) Since November 2018 Better Lives has : § Offered a new structured day programme This programme is based at the King Henrys Walk site and runs Monday to Friday. It is a twelve-week psychosocial programme covering a variety of topics that are offered as a rolling programme. § Offering more targeted group sessions across all service sites These include Alcohol Education, Women's groups, Men groups, Coping with Traumatic Events, Skills for Abstinence, a “peer mentoring” course and a “Giving Something Back” group and mutual aid groups (AA, CA SMART groups). § A renewed focus on reducing drug related deaths Better Lives is working hard to ensure Naloxone is distributed to as many people at risk of overdose as possible, and that service users are trained in its use through a rolling monthly training Programme. The service also provides training on substance misuse and Naloxone for a wide range of professionals twice a quarter, including staff from supported housing, mental health and community sites. § Raised awareness of drug and alcohol harm and how to support people using substances There have also been substances misuse awareness training held as Community Conversations in Islington Town Hall.
Better Lives update cont’d § Developed its partnership working There are established Single Points of Contact (SPOCs) with housing / supported housing and Better Lives to improve joint working and to better Support service users. Better Lives has attended borough events and partnership meetings to promote the service and to enhance their footprint in the borough with a passionate commitment to partnership working and identifying and meeting unmet need in Islington. § Continued its support of street outreach activity Better Lives works in partnership with the St Mungo’s outreach team. The areas that have been targeted in the first part of this year have been Finsbury Park, Upper Street, Archway and behind Morrison’s on Holloway Road. § Supporting people with poor health The service is adapting to the changing needs of service users and specifically those service users who have increasing health risks and needs, including poor mobility, deteriorating mental health or who are difficult to engage in treatment. The service is supporting them through home visits and through joint working with Groundswell, encouraging people to attend health appointments. § Seeking feedback from service users Comments include: “ A service where you will feel safe and not be judged ... This service is a lifeline, like a rope across a river. You hold on and at points across the river someone helps you not to lose your grip on the rope” “It will greatly improve your mental wellbeing and help you with tools to cope with what life brings …I should have done this years ago !”
Themed feedback: Better Lives Family Service The Better Lives Family Service is a therapeutic service for children, young people and adults whose lives are affected by someone else’s drug or alcohol use. This is a new feature of the local service offer, established as part of the new contract. In year 1 of Better Lives (2018/19), the family service received 80 referrals. In just Qs 1& 2 of 2019/20 there has been 49 referrals and this increase is expected to continue. There is a range of support available including group sessions and shortened interventions as needed in order to meet the varied needs of those seeking assistance. For families, partners and friends of those affected by substance use, the service offers a “Focus on Me” group. All those who have started this group have completed the sessions and have developed their own Peer Support Group. It is hoped that those involved will support the service in developing this as a long term peer led group. More recently, the Family Service has made links with the Young Carers Group. The aim is to hear from young carers what they feel would help them in understanding what their parents / guardians are experiencing.
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